The Current Unmet Need in Type 2 Diabetes Mellitus: Addressing Glycemia and Cardiovascular Disease

The treatment of type 2 diabetes mellitus (T2DM) requires a multifaceted approach of both lifestyle modification (diet, exercise, weight control, smoking cessation) and pharmacological therapy. In addition to agents that improve hyperglycemia, patients often require treatments to address the additional cardiovascular (CV) risk factors of hypertension and dyslipidemia. Although the benefits of early, aggressive glycemic control are clearly established, treatment remains suboptimal. Many patients fail to achieve long-term glycemic control, with rates of patients with T2DM achieving target goals for hypertension and dyslipidemia also unsatisfactory. Several factors contribute to the failure to meet treatment goals. These include poor adherence by patients to lifestyle and pharmacological treatment, lack of understanding by patients of the long-term benefits of treatment, patient concerns about adverse effects leading to poor compliance, and failure of health care providers to initiate or intensify medications appropriately (termed clinical inertia). This article reviews the current state of T2DM treatment and the management of CV risk factors associated with T2DM, and identifies unmet treatment needs.